Increase in Congenital Syphilis in Maricopa County, Physicians Reminded Of Testing Requirements

Congenital Syphilis is a condition in which a pregnant woman with syphilis transmits the infection to her baby. Syphilis is connected to numerous adverse outcomes and often goes unnoticed or misdiagnosed due to vague symptomology.

Testing Requirements

Arizona law requires syphilis testing (e.g. RPR reflex to TPPA) during the first prenatal visit or first medical visit during pregnancy, which may include urgent care or emergency department settings.

As a high morbidity county, ALL pregnant women should have repeated syphilis screening early during the third trimester and at delivery.

Infants should not be discharged from hospitals until the syphilis serologic status of the mother is known. Infants born to women with reactive RPRs must have RPR tests themselves.

Treatment Guidelines

Pregnant women diagnosed with syphilis must start treatment (Bicillin no less than 30 days before delivery and complete all doses)

Documentation and Reporting

All syphilis test results and treatment should be thoroughly documented in the medical records of both mother and baby.

Reactive syphilis tests must be reported to public health within 24 hours. Maricopa County maintains as up to date records of syphilis tests as possible with these reports, which is an ideal resource for providers serving new patients. Health Advisors are ready to assist you at 602-506-5435 or 602-506-6205. https://www.stdaz.com

Symptomology

Anemia

Jaundice

Hepatosplenomegaly

Long bone deformities

Skin lesions

Skin rash

Skin peeling

Primary sore

Mucous membrane lesions

Supplemental Labs

Reactive CSF VDRL

Elevated CSF protein

Elevated CSF WBC

Maricopa County Congenital Syphilis Rates Have Doubled Since 2016

National & County Statistics:

From 2014 to 2018, Maricopa County congenital syphilis cases nearly tripled with a 50% increase from 2017 to 2018 alone.

Between 2016 and 2018, the proportion of syphilis cases among females rose from 17% to 25%. In the same time frame, total female syphilis cases more than doubled.

In 2018, 5 of 30 congenital syphilis cases in Maricopa County resulted in fetal demise of the infant either by stillbirth or infant death shortly after delivery.

Syphilis Serologic Tests for Screening and Diagnosis

Screening Nontreponemal Tests – Become negative following treatment.

Detect both IgM and IgG antibodies (detectable as early as 6 days postinfection).

Rapid plasma reagin (RPR) – best screening test for blood

Detects and measures Treponema pallidum antibodies in blood

Repeat RPR used to monitor treatment effectiveness following antibiotics

Titers should drop following treatment; unchanged or rising levels could indicate reinfection or treatment failure.